Nurse Medical Case Manager - Workers Compensation
Travelers
Utilization Management Nurse Consultant - Remote
CVS Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $29 - $62 per hour
Job Level
Mid-LevelSenior
About the role
- Apply critical thinking and evidence-based clinical criteria to evaluate outpatient and inpatient services requiring precertification.\n
- Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information.\n
- Use established guidelines to authorize services or escalate to Medical Directors as needed.\n
- Navigate multiple computer systems efficiently while maintaining accurate documentation.\n
- Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills.\n
- Perform sedentary work that primarily involves extended periods of sitting, as well as frequent talking, listening, and use of a computer.\n
- Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring continuity of care and operational support.\n
- Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.
Requirements
- Active unrestricted state Registered Nurse licensure in state of residence required.\n
- Minimum 5 years of relevant experience in Nursing.\n
- At least 1 year of Utilization Management experience in concurrent review or prior authorization.\n
- Strong decision-making skills and clinical judgment in independent scenarios.\n
- Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms.\n
- Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation.
